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2020, vol. 37, br. 2, str. 180-190
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Stopa i uzroci smrtnosti majki u južnom Iranu
Maternal mortality rate and its causes in the south of Iran
aShiraz University of Medical Sciences, School of Health, Department of Epidemiology, Non-Communicable Diseases Research Center, Shiraz, I.R. Iran bShiraz University of Medical Sciences, Shiraz Geriatric Research Center, Shiraz, I.R. Iran cShiraz University of Medical Sciences, Office of Vice Chancellor for Health Affairs, Shiraz, I.R. Iran dShiraz University of Medical Sciences, Student Research Committee, Shiraz, I.R. Iran eUniversity of Texas Health Science Center at San Antonio, Department of Neurosurgery, San Antonio, Texas, USA fShiraz University of Medical Sciences, Institute of Health, Health Policy Research Center, Shiraz, I.R. Iran
e-adresa: moghadami@sums.ac.ir
Projekat: The authors would like to acknowledge the research vice-chancellor of Shiraz University of Medical Sciences for cooperation and the financial support of dissertation proposal number 91-6314.
Sažetak
Stopa smrtnosti majki obično odražava stepen razvoja jedne zemlje. U ovoj studiji prikazana je incidencija (stopa) smrtnosti majki i razmatrani su povezani faktori rizika u provinciji Fars, na jugu Irana. Primenom sistema za nadzor Univerziteta medicinskih nauka u Shirazu, pregledani su kartoni novorođene dece u periodu od 2002. do 2012. godine, kada je zabeležena i smrtnost majki. Od 747.077 trudnoća, prosečna stopa smrtnosti majki iznosila je 21,28 na 100.000 novorođene dece godišnje, pri čemu je uočen smanjen i nesignifikantan trend. U ruralnim oblastima, stopa smrtnosti majki bila je duplo veća nego u gradskim oblastima. Najčešći uzrok smrtnosti majki bili su krvarenje (27%), zatim preeklampsija (15,7%) i infekcije (13,2%). Premda se stopa smrtnosti majki smanjila, smanjenje nije signifikantno. Na osnovu povećane stope smrtnosti majki u ruralnim oblastima, trebalo bi poboljšati negu majki, naročito posle porođaja. Krvarenje je i dalje glavni uzrok smrtnosti majki u provinciji Fars. S obzirom na to da se visok procenat ovakvih slučajeva može sprečiti, pojačana zdravstvena nega tokom trudnoće, smanjenje broja carskih rezova, bolja opremljenost zdravstvenih ustanova, kao i postojanje timova za kontrolu krvarenja u porodilištima, verovatno će značajno uticati na stopu smrtnosti majki.
Abstract
The maternal mortality rate (MMR) often reflects the development status of one country. This study calculates the incidence rate of maternal mortality and examines the related risk factors in Fars Province, located in South of Iran. Using the surveillance system of Shiraz University of Medical Sciences, we reviewed all childbirth records from 2002 to 2012 in which maternal mortality occurred. Of 747,077 pregnancies, the average MMR was 21.28 per 100,000 live births per year, with a decreasing but non-significant trend. In rural areas, the MMR was more than twice as high as in urban areas. The most common cause of maternal death was maternal hemorrhage (27%), followed by pre-eclampsia (15.7%) and infections (13.2%). Although the MMR gradually decreased, this decrease was not significant. Based on the higher MMR in rural areas, maternal and specialty post-partum care in rural areas should be improved and promoted. Hemorrhage is still the main cause of maternal mortality in Fars Province. Since high percentage of these cases are preventable, increased healthcare during pregnancy, reduction of cesarean sections, more well-equipped facilities, and hemorrhage-control teams in maternity hospitals would likely have a significantly positive impact on MMR.
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